69-702 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. �' ��; �y -=--------- --- ------- ------ ---------------- ---------- --- {Complete in Triplicate), Date issued __._ ,W, 0 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOS ADDRESS/LOCATION _._-_2$8��'�� ©."__j�OS' ___ Q ;di:� Txacy -------------CENSUS TRACT -------------- ----------- j t ----------Phone —835!!3762----------- Owner's Name ------M��--M9J'_le._TDPeS-�------------ =------------------'-------------= ----- -----=-I-- ---- - 262--W•--Linne--RD4d----------------`` City ra - 995 4 --------m-4--j----=---_-!----- ------ ---- -- --- � ----- Contractor's Name _.--- 'k-LmQ P�rI1hIBT_GSHV ----=--- --.License # -.� hone _� '_ _//`f.. Installation will serve: Residence artment House Commercial Trailer Court ',❑ P 0 ❑ Motel ❑Othe'r -----------------�-----------------•-------- 2 ' P'-- Lot Size ----AC—eTA$O---------------•---- Number of living units:________ Number of bedrooms ______"__,__Garbage Grinder _.__ .. ;) Private En Water Supply: Public System and name ------------------------------------------------------------- - - - ---------------------------------- y, g Character of soil to a depth of 3 feet: Sand"❑ Sp-i�lt'❑;"'CIaY ❑ Peat E] Sandy Loam [:1 Clay Loam.❑ Hardpan F] (Adobe M.Fill Material ------------ If yes,type --------------------------- w, 1 (Plat plan, showing size of lot, location of systph in relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) }-- -------------- ------- Liquid Depth _lka[t'-=-------------- PACKAGE TREATMENT [ ] SEPTIC TANK', 3 Size--- f+ p ----- Distance 2 �--� Capacity .12.00-------- Type- FTe" IMaterlal---�pI1C 'e sNo. Compartments �. to nearest: Well - `_�OO�___ ______________Foundation ____1- �------ Prop. Line -------- 01.------ 1 Z--------___ Len th' of each line------------$0t- Total Length ____--160±.___...."_-- LEACHING LINE [�` No. of Lines __._-__- - _� ,9 _� -- - " _ _rt� : �"� I W _ 'D' Box _---- ,_ _ T pe Filter Material a p- th Filter Material., ty ------ Distance to Weare t: Well ---- l Of--6� Foundation p 2- - -- Property Line ❑�---•. "-,- t ___ Rock Filled Yes No I SEEPAGE PITS [ I Depth ------------------ - Diameter Number ❑ , Water Table Depth __ ----------- ----_-Rock Size --------- ---------------------- t ` Foundation Prop. Line ------------- '�+ - Distance to nearest: Well ---------------------- -- f ---- ----------------- Date �) � --- REPAIR/ADDITION(Prev. Sanitation Permit# ""-"----.--_-�-- r � ' Septic Tank (Specify Requirements) -------------------- --------------------------- ----- ----------------------------•---- Disposal Field (Specify Requirements) ------------ ---------------------------------------------------------------------- - - -------------------- --------------------------------- ----- -------- ---- {Draw existing and required addition on reverse s d e ' 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agenfs signature certifies the following: 1 "I certify!that in the performance of the work for which this ermit is issued, I shalt not employ any person in such manner �� la s of if ia." as to beco��j�c�olc"d�lf� �@jia "160 EAST GRANTLINEZSigned --- ----------------- --0f--Z0X---254- )ROAD pw+Re $ ntAC_Ye CALIEORN_ER If Title -- '---------------------------- ,. . (If other than owner) PIUM �IKG �°IRV'tC"� FOR DEPARTM T USE, 0 Y ;r f, ' _ /1� ------------------- APPLICATION ACCEPTED BY ------------ ----------------------------------- DATE -----�----_ . BUILDING PERMIT ISSUED --------------- --_:-,. :.:-,:,. ..�,;------ -` - DATE ADDITIONAL COMMENTS ------------------------- _.. �._ _- ------------- -- -- ----------------------- ---------- _ ------------ --------------------------------------------------- --J - - - -- -- - ---------- ------------------- ------- --------------------------------------------- -'- Date "- - Final Inspection b ' p Y SAN JOA QUIN LOC HEALTHaSTRICT E. H. 9 1-'68 Rev. 5M. �